<?xml version="1.0" encoding="utf-8"?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
  <head>
    <title>Report Error</title>
    <link rel="stylesheet" type="text/css" href="styles.css"/>
  </head>
  <body>
  
	<p>
	Report Error:<br/>
	[Incorrect entry specifics from php]<br/>
	</p>
	
	<form action="">
	<div class="left_side">
		Correct value:<br/>
		Correction Reason:<br/>
	</div>
	<div class="middle_cont">
		<input type="text"/><br/>
		<textarea rows="2" cols="20"></textarea>
	</div>
	<p>
		<input type="submit" value="Submit" class="button" onclick="javascript:window.close()"/>
	</p>
	</form>

  </body>
</html>